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Financial incentives may influence oncologists’ practice patterns
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Some oncologists may alter treatment recommendations for patients in some cases based on personal revenue considerations, according to results of a systemic review of studies on physicians’ responses to reimbursement incentives.
Researchers recommended implementation of more value-based reimbursement policies to ensure physician incentives are more closely aligned with patient need.
“I would not see value-based reimbursement in oncology as being akin to the [Hospital Readmission Reductions Program] put in place by the [Affordable Care Act],” Aaron P. Mitchell, MD, MPH, medical oncologist in the department of epidemiology and biostatistics at Memorial Sloan Kettering Cancer Center, told HemOnc Today. “One example of value-based reimbursement can be seen in the Oncology Care Model, in which oncologists have a target overall treatment cost for each patient and get payment bonuses for staying under that target. That incentivizes doctors to use less expensive treatments where available, rather than incentivizing them to use more expensive treatments, as our current reimbursement system does.”
Mitchell and colleagues evaluated whether financial incentives associated with oncology reimbursement influence practice patterns and delivery of care.
The researchers searched five databases and reviewed 18 observational cohort studies that addressed oncology reimbursement incentives by analyzing differences in physician compensation for the same treatment; practice structure and/or self-referral arrangements for oncology services; or physician behavior in response to changing reimbursement for services over time.
Most of the studies had a moderate risk for bias.
Fifteen (83%) of the 18 studies showed an association between reimbursement and delivery of care consistent with physician responsiveness to monetary incentives.
The results consistently showed an association between self-referral arrangements and increased the use of radiotherapy, and that profitability linked to certain anticancer drugs may affect physicians’ choice of drug.
The findings were less conclusive, however, as to whether the profitability of systemic anti-cancer therapy affects physicians’ decisions to use it.
“A change that could be put in place would be to stop paying oncologists a percentage of chemotherapy drug [costs] and replace the lost revenue with higher reimbursement for other care services,” Mitchell told HemOnc Today. “This would allow oncologists to use expensive drugs when necessary without taking on financial risk but remove the incentive to use expensive drugs because of their profitability.”
A limitation of the study was that researchers could not directly compare behavior of oncologists in the U.S. with those in other countries because of the different health care systems.
“Our findings should not be taken to imply that financial motivation is the only — or even the predominant — factor influencing physician practice in oncology,” Mitchell and colleagues wrote. “Many of the included studies found evidence that other factors appropriately drive treatment decisions, such as strength of clinical evidence for a treatment or patient disease characteristics.” – by John DeRosier
For more information:
Aaron P. Mitchell, MD, MPH, can be reached at Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 485 Lexington Ave., Second floor, Office 2093, New York, N.Y. 10017; email: mitchea2@mskcc.org.
Disclosures : Mitchell reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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Mitchell A, et al. JAMA Oncol. 2019;doi:10.1001/jamaoncol.2018.6196.
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